Provider Demographics
NPI:1710341268
Name:BRENNICK, CAROLINE (DO)
Entity type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:
Last Name:BRENNICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9430
Mailing Address - Fax:239-343-9495
Practice Address - Street 1:8960 COLONIAL CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7803
Practice Address - Country:US
Practice Address - Phone:239-343-9430
Practice Address - Fax:239-343-9495
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17684208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110894000Medicaid